Laparoscopic Cholecystectomy has superseded open cholecystectomy as the preferred method. One limitation of laparoscopic cholecystectomy as preferred to open cholecystectomy is in dealing with common bile duct stones. Laparoscopic CBD exploration is time consuming, needs harder ware, is an intensive procedure, has steep learning curve and risks injury to Common bile duct. The data was collected in a proforma approved by the guide. The diagnosis was made with relevant clinical history, physical examination, relevant investigations-Liver function tests, ultrasound-abdomen, endoscopic retrograde cholangiogram, CT-scan abdomen. All patients were worked up for the therapeutic procedures with all routine lab investigations, ECG, chest Xray and fitness for the procedure was taken from the physicians where ever necessary. In this study of 60 patients, 34 patients had no complications. 3 patients had wound infection. In 4 patients along with wound infection cholangitis and sepsis (1 each), pancreatitis in one patient and bile leak in one patient was observed. Each of the 5patients had pancreatitis and sepsis. Cholangitis was observed in 3 patients and 2 patients had bile leak through t-tube tract following its removal which persisted for 6 and 7 days respectively. Cholangitis along with pancreatitis, sepsis, bile leak was observed in 1, 1, 2 patients respectively.
The management of patients with known bile duct stones as well as gallbladder stones will vary between countries and between institutions. Factors that influence decision making processes within institutions include the availability of experienced surgeons and endoscopists, costs of hospitalization, costs of endoscopic and laparoscopic equipment, and patient preference. Patients were subjected for the different procedures namely ERCP, open or laparoscopic CBD exploration, or combination of one or more above mentioned procedures, depending upon the need and or the indications. In this study ultrasound abdomen detected the presence of common bile duct (CBD) stones in 55 of 60 patients, accounting for 91.6%. Size of the stone was mentioned 55 patients, whereas in 5 patients no mention was made regarding the size. Out of 55 patients 17 patients had single stone in the CBD whereas 38patients were found to have multiple calculi. CBD dilatation was found in 53patients, out of which no mention was made about the size of duct in 3 patients, 16 patients were found to have duct dilatation of less than 10mm and rest 34 patients showed duct dilatation of more than 10mm.In 06 patients no duct dilatation was found and in 1 patient USG findings were inconclusive.
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